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Engaging citizens in whole system change processes

In Karelia, Finland, for example, citizens played a critical role in re-designing the public health system. They launched a petition in 1972 to get help to reduce the high incidence of cardiovascular disease. The result – the North Karelia Project – was a collaboration between local and national authorities, experts and local citizens. Together they formulated and implemented a series of community based interventions intended to prevent the incidence of cardiovascular disease. The project has had a dramatic impact, helping to reorganise the health system around prevention and healthy living, and by involving citizens in the design and implementation of the programme acted as a process for community learning. The project has acted as a major demonstration programme for national and international applications.